What is the role of UpToDate in medical education?

I wrote the following tweetorial last week and the response was amazing. Seems like everyone had an opinion.

A med student answered a question and was very nervous to say he learned it from UpToDate. He wasn't sure how I felt about UpToDate. He then pointed to this exchange from @OnlineMedEd where one of the teachers disparages UpToDate https://t.co/TQ42Bbsp0E pic.twitter.com/8zMK6uWsXl

— Joel M. Topf, MD FACP (@kidney_boy) September 5, 2019

The poll at the end of the tweetorial had over 1,500 votes with 90% split between “Definitive source” and “Equivalent to other textbooks”

What are your thoughts on UpToDate?

— Joel M. Topf, MD FACP (@kidney_boy) September 5, 2019

A recurring thought among commenters was that textbooks are great for providing overviews and UpToDate is a more practical reference that will be both up-to-date and provide specific recommendations for your clinical question. I remember talking to Burton “call me Bud” Rose when he was hawking a still incomplete UpToDate in the halls of ASN Renal Week in the 90s. One thing he drilled in on was that his cards (a card is a single entry in UptoDate) always finish with a specific recommendation. He viewed this as a critical differentiator for UpToDate. He made his writers not just provide the data but pick a side.

One great comment was by Poonam Sharma

Better than textbook (more likely to be…UpToDate) but narrative review not systematic review so you don’t know what you are missing. Great for next steps and MOC but not for prepping a talk.

— Poonam Sharma (@PoonamSS) September 5, 2019

I think this might be the source of some physicians distaste for UpToDate. When we have a resident give a presentation to teach the rest of the team or residency, or fellowship program we want people to dig deeper than summarizing UpToDate.

Additionally people kept commenting on the importance of going to the primary literature. This is great in principal, but in practice the volume of primary literature is overwhelming. The KDIGO 2012 blood pressure recommendations have 453 references on blood pressure alone. If you seek to be an expert, going down the rabbit hole of primary literature is essential, but if you want to put all of that training to use taking care of patients, it is best to stick with guidelines, review articles, and, yes, UpToDate.

One final note, the villain of the initial tweet, Dustyn Williams, contributed to the conversation.

I've come a long way since this comment; it certainly could be worded better. Of course full context helps, but that aside I was not disparaging any one specific person. I find utd helpful for me, but not for students. And yes, there are problems with it. But that is universal

— Dustyn Williams, MD (@DustynWilliams) September 6, 2019

This is a model with how to deal with this type of hullabaloo. He avoided any ad-hominem defensiveness. He stated that this was a long time ago and he is no longer the same person. His thoughts on the topic have evolved. Nicely done. God knows what inappropriate and emotional things I have typed out in the past. And I am sure most of us will, in the future, need to deal with years-old statements returning zombie-like to chase us down. Dr. Williams provides an admirable model to follow.

COI: I am the author of a medical textbook.